摘要目的 比较恩替卡韦与拉米夫定预防合并既往乙肝感染[HBsAg(-)／HBcAb(+)]的B细胞非霍奇金淋巴瘤(B-NHL)患者利妥昔单抗联合化疗HBV再激活的有效性.方法 采用回顾性研究的方法,分析自2012年1月至2018年1月烟台市三所医院收治的B-NHL且资料完整的患者216例,其中既往乙肝感染者78例,根据临床需要分为拉米夫定预防组(17例)、恩替卡韦预防组(11例)和对照组(50例).分析含利妥昔单抗联合化疗前后B-NHL患者HBVM、HBV DNA和肝功能指标变化,比较各组化疗后HBV再激活、肝功能损害、化疗延迟等方面的差异.结果 既往乙肝感染的78例患者中,有7例出现HBV再激活,与其余71例进行比较,两者在性别、年龄、病理类型、化疗疗程之间差异无统计学意义.对照组中6例患者出现HBV再激活(12.00%),ETV组无患者出现HBV再激活,LAM组1例患者出现再激活(5.88%),三者之间差异有统计学意义(Fisher精确概率法,P＝0.016).发生乙肝再激活的时间:化疗第1疗程有2例患者,第3疗程2例患者,第4疗程1例患者,第5疗程1例患者,化疗结束后1例患者. 4例HBsAg血清转阳,分别发生在化疗的第1、3、5疗程及化疗结束后.对照组有20例(40.0%)出现肝功损害;拉米夫定组4例(23.5%)出现肝功损害,恩替卡韦组2例(18.2%)出现肝功损害.结论 合并既往乙肝感染的B-NHL患者应用利妥昔单抗联合化疗方案后,预防应用核苷类抗病毒药物可以明显降低HBV再激活,恩替卡韦比拉米夫定更能降低HBV再激活的风险.

abstractsObjective To investigate the efficacy of enticavir and lamivudine in preventing rituximab -asso-ciated hepatitis B virus ( HBV) reactivation in patients with B -cell non -Hodgkin lymphoma complicated with resolved hepatitis B during chemotherapy.Methods This retrospective study included 216 B-cell non-Hodgkin lymphoma patients with complete data from January 2012 to January 2018 treated in 3 hospitals.Of 78 patients with resolved hepatitis B,they were divided into lamivudine prophylactic group (17 cases),entecavir prophylactic group (11 cases) and control group ( 50 cases ).The changes of HBVM, HBV DNA and liver function before or after rituximab combination chemotherapy were analyzed.The incidence of HBV reactivation , liver function injury and chemotherapy delay were compared.Results Compared to the other 71 patients,7 cases experienced HBV reactiva-tion in 78 patients with resolved hepatitis B.There were no statistically significant differences between the two groups in patient demographics ,pathological pattern,chemotherapy regimen.Six patients in the control group developed HBV reactivation(12%) and 1 patient in lamivudine prophylactic group (5.88%),none had HBV reactivation in enticavir prophylactic group.There was statistically significant difference among three groups ( Fisher P＝0.016).A total of 7 cases experienced HBV reactivation in 78 patients with resolved hepatitis B respectively ,2 cases in the first chemo-therapy period,2 cases in the third chemotherapy period ,1 case in the fifth chemotherapy period ,the last one occurred after the completion of chemotherapy.Four patients had HBsAg reverse seroconversion ,occurred in the 1,3,5 cycles during and after the completion of chemotherapy.Twenty patients (40.0%) experienced liver function parameters abnormal in the control group,4 cases (23.5%) in lamivudine prophylaxis group ,2 cases (18.2%) in enticavir prophylaxis group during chemotherapy.Conclusion Antiviral prophylaxic therapy can potentially prevent rituximab associated HBV reactivation in patients with resolved hepatitis B.Entecavir can more reduce the risk of rituximab associated HBV reactivation than lamivudine.